Open Close Rules

Claim Open / Close

Reason: Clients and companies like Travelers, Marsh, etc., have been asking for a date a claim was closed and information on how many claims have been re-opened. In order to provide this functionality Compensate needs to track the dates when a claim is opened, closed and re-opened.  This is a departure from the current functionality where a claim open / close status is determined by the current reserve.

            For the v6.0, the open / close flag will be completely under the control of the claims manager and will disregard the reserve on file in the claim.  This means that there will be claims of all types that are currently considered open but they have no reserve set.  Below is a list of proposed rules for the new feature.

Permission to Open / Close a claim

• 1. The permission to open / close a claim will be attached to the current permission to adjust reserves on a claim.

Automatic Open / Close

• 1. When a claim is added and there is a reserve established (Ex. Reserve for Medical Only), the claim will be automatically opened on that date. The claim will only be opened if the check box for Reserve for MO is used.  If you enter a claim set the type to LT and do not use the check box the claim will be closed.

  2. When a claim is added and there is no reserve established (Ex. Incident Only Claim) the claim will not be opened automatically and will show on all reports as closed.

When the Claim is Closed

• 1. Closed claims can not have a reserve

  2. No payments will be allowed / not even expense payments.

  3. No reserve adjustments will be allowed without authorization to open / close claims.

  4. Denied payments may not be entered.

  5. If the claim is currently closed and there is authorization to open / close claims there will be a prompt to make sure you wish to open / re-open the claim

  6. Auto-pay transactions will fail for closed claims.  If a claim is in auto-pay, the claim will have to be re-opened from the menu inside the claim.

  7. The Attorney check program will not allow payments on closed claims.  Closed claims will have to be re-opened from the menu inside the claim.

  8. No recoveries or credits will be allowed for closed claims.  In order to record a credit to the claim the claim must be re-opened.

  9. No EDI reports may be filed on closed claims

  10. No Hearings may be scheduled for closed claims.

  11. The user will be able to

      1. Adjust quits and returns dates

      2. Add / Edit Case notes

      3. All reports

      4. Manage ICD9, ICD10 Codes, as appropriate

      5. Add a claim to auto-pay (see note above about auto-pay)

      6. Manage claim data

      7. Set indemnity authorization dates

  12. Form letters